Comorbidity as a risk factor for overall survival and decision criteria for intensity of chemotherapy in elderly patients with acute myeloid leukemia

Đjunić, Irena; Virijevic, Marijana; Novkovic, Aleksandra; Djurasinovic, Vladislava; Čolović, Nataša; Vidović, Ana; Suvajdzic-Vukovic, Nada; Tomin, Dragica

doi:10.1007/s12032-011-9853-8

Cited by 27 publications

(29 citation statements)

References 16 publications

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“…In the field of oncogeriatrics, distinguishing the frail elderly may influence subsequent decision-making. [16][17][18][19] This work was carried out to identify which demographic factors and/or which elements of the CGA allowed prediction of the risk of frailty as measured by the BQ. The only factors that have been found to act as predictors of the risk of frailty are age, marital status (unmarried) and dependence in IADL.…”

Section: Discussionmentioning

confidence: 99%

Ability of the Comprehensive Geriatric Assessment to Predict Frailty in Older People Diagnosed with Cancer in a General Hospital

Molina‐Garrido¹,

Guillén‐Ponce²

2012

European Oncology &Amp; Haematology

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The field of oncogeriatrics considers the comprehensive geriatric assessment (CGA) as the main tool for distinguishing between patients who are frail and those who are not frail. The aim of our study was to determine the role of the CGA in predicting the risk of frailty in elderly patients. This prospective study was conducted at the Cancer in the Elderly Unit of the Medical Oncology Department at the Virgen de la Luz General Hospital in Cuenca, Spain. Demographic data and information about the CGA were collected. Using a bivariate logistic regression analysis, these factors were analysed and the factors that are associated with the risk of frailty were determined, as measured by the Barber questionnaire (BQ). We included 262 patients in the study with a mean age of 79 years (range 70-93 years). Seventy-four percent of the patients (n=194) had a risk of frailty as measured by the BQ. In the bivariate analysis, only age (odds ratio [OR] As the term 'frailty' is problematic, an operational definition of frailty has been used in this article based on the Barber questionnaire (BQ). This is the most widely used questionnaire for identifying risk to the elderly in the outpatient setting. 10,11 In general, it integrates, in a first-stage screening process, global strategies intended to more fully assess and intervene in selected elderly patients at risk, helping to prevent the occurrence of adverse events (mortality, hospitalisation or institutionalisation) in the short to medium term. 10-12Our study's aim was to determine which components of the comprehensive geriatric assessment (CGA), patient demographics and tumours predict which elderly patients diagnosed with cancer have a risk of frailty and which do not. It also seeked to develop a predictive model based on such characteristics and determine its predictive power. Materials and MethodsBetween March The CGA model used was specifically designed by the authors of this article and represents the first model created for the elderly Spanish

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Section: Discussionmentioning

confidence: 99%

Ability of the Comprehensive Geriatric Assessment to Predict Frailty in Older People Diagnosed with Cancer in a General Hospital

Molina‐Garrido¹,

Guillén‐Ponce²

2012

European Oncology &Amp; Haematology

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“…Older AML patients often have comorbidity (18, 19, 24–27). For example, a study using population data (SEER) including over 5000 adults diagnosed with AML (median age 78) showed that half had atleast one major comorbidity based on claims data(7).…”

Section: Individualizing Patient Assessment: Deconstructing Chronologmentioning

confidence: 99%

“…The most commonly used indices are the Charlson Comorbidity index (CCI) and the Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI)(28, 29). Many studies of older adults with AML have shown a relationship between increased comorbidity burden (measured by CCI or HCT-CI) and worse outcomes including decreased remission rates, increased risk of 30-day mortality and worse overall survival (OS) (18, 24–26, 30, 31). Several studies, however, have not shown such a clear relationship (27, 32, 33).…”

Section: Individualizing Patient Assessment: Deconstructing Chronologmentioning

confidence: 99%

Elderly Acute Myeloid Leukemia: Assessing Risk

Klepin

2015

Curr Hematol Malig Rep

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Treatment of older adults with acute myeloid leukemia (AML) is challenging in part due to the difficulty of accurately predicting risks and benefits of available therapies. While older patients represent the majority of those with newly diagnosed disease, there remains no consensus regarding optimal therapy. Older age is associated with increased risk of treatment-related toxicity and worse survival compared to younger adults. Age-related outcome disparity in the setting of AML therapy is clearly attributed in part to differences in tumor biology conferring resistance to therapy. However, physiologic changes of aging that decrease treatment tolerance also influence outcomes and vary among patients of the same chronologic age. Measurable patient characteristics such as comorbidity and physical function can reflect the heterogeneity of physiologic aging among older patients and help predict resilience during and after the stress of diagnosis and treatment. To improve outcomes for older adults with AML it will be critical to investigate the predictive utility of patient characteristics in parallel with tumor biology to improve decision-making, inform trial design, and identify actionable targets for supportive care interventions. This review will focus on available data addressing risk assessment for older adults treated for AML with a focus on patient characteristics that may reflect vulnerability to poor treatment tolerance.

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“…15 Higher HCT-CI scores are associated with higher mortality. 12,[16][17][18][19] An MDACC study in 177 elderly AML patients (age 460) showed that early date rates were 3%, 11%, and 29% in patients with HCT-CI scores of 0 (n ¼ 39), 1-2 (n ¼ 53) and X3 (n ¼ 85) (Po0.001), respectively. Median OS was inversely affected by higher HCT-CI scores (median OS was 45, 31 and 19 weeks in these three groups, P ¼ 0.04).…”

Section: Induction Therapymentioning

confidence: 99%

To transplant or not: a dilemma for treatment of elderly AML patients in the twenty-first century

Üstün

Lazarus

Weisdorf

2013

Bone Marrow Transplant

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AML treatment presents significant challenges in the elderly, who more often have poor risk cytogenetic and molecular markers, comorbidities and compromised performance status. Although population-based studies indicate that treated patients' survival is better than those who are not treated, there is an understandable reluctance of physicians to choose aggressive therapy. Even in this older population 40-60% CR rates are achievable. Several scoring systems and web-based programs help to predict TRM and CR rates. These sources can assist physicians in the difficult decision-making process of aggressive therapy in an individual patient. Clofarabine and hypomethylating agents are reasonable options and can induce CR in patients who cannot receive standard induction with anthracyclines and cytarabine. Despite encouraging CR rates, median survival remains short (o12 months) in elderly AML patients. Even those patients achieving CR have limited long-term survival (B20% at 3 years) without allogeneic hematopoietic cell transplantation (alloHCT). AlloHCT is feasible and can provide approximately 40% survival at 2 years in appropriately selected patients. Although increased age is associated with poorer survival, higher comorbidities and poor performance status have more negative impact than age per se. The short duration of CR demands that leukemia and transplant physicians collaborate immediately after diagnosis to move quickly toward alloHCT. This collaboration is also essential to choosing the right individuals to transplant and to bridging post-remission therapy (intermediate-dose cytarabine, a hypomethylating agent or FLT-3 inhibitor) in this sometimes frail population. Future studies should be designed not only to address who should receive alloHCT, but also to improve our understanding of AML biology and the process of its cure.

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Comorbidity as a risk factor for overall survival and decision criteria for intensity of chemotherapy in elderly patients with acute myeloid leukemia

Cited by 27 publications

References 16 publications

Ability of the Comprehensive Geriatric Assessment to Predict Frailty in Older People Diagnosed with Cancer in a General Hospital

Ability of the Comprehensive Geriatric Assessment to Predict Frailty in Older People Diagnosed with Cancer in a General Hospital

Elderly Acute Myeloid Leukemia: Assessing Risk

To transplant or not: a dilemma for treatment of elderly AML patients in the twenty-first century

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